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How is vaginal cancer diagnosed?

If a woman has any of the signs or symptoms of vaginal cancer, she should see a doctor. If the Pap test detects abnormal cells, or if the pelvic exam results are not normal, more tests will be needed. This may mean referral to a gynecologist (specialist in problems of the female genital system).

Medical history and physical exam

The first step is for the doctor to take a complete medical history to check for risk factors and symptoms. Then your doctor will physically examine you, including a pelvic exam and possibly a Pap test and a vaginal biopsy.

Colposcopy

If certain symptoms suggest cancer or if the Pap test shows abnormal cells, you will need to have a test called colposcopy. In this procedure you will lie on the exam table as you do for a pelvic exam. A speculum is placed in the vagina. The doctor will use the colposcope to examine the cervix and vagina. The colposcope stays outside the body and has magnifying lenses (like binoculars). When the doctor looks through the colposcope, he or she can see the vaginal walls and the surface of the cervix closely and clearly. Sometimes a weak solution of acetic acid (similar to vinegar) or iodine is applied to make any abnormal areas easier to see. Using a colposcope to look at the vagina is called vaginoscopy.

Colposcopy itself is no more painful than a speculum exam and can be done safely even if you are pregnant. If an abnormal area is seen on the cervix or vagina, a biopsy will be done. The biopsy can be slightly painful and may some cause pelvic cramping.

Biopsy

Certain signs and symptoms may strongly suggest vaginal cancer, but many of them can be caused by conditions that aren’t cancer. The only way to be certain that cancer is present is to do a biopsy. In this procedure, a small piece of tissue from the suspicious area is removed. A doctor specializing in diagnosing diseases by laboratory tests (a pathologist) will look at the tissue sample under a microscope to see if cancer or a pre-cancerous condition is present and, if so, what type it is.

Imaging tests

Chest x-ray

If vaginal cancer is diagnosed, a plain x-ray of your chest may be done to see if your cancer has spread to your lungs. This is very unlikely unless your cancer is far advanced. This x-ray can be done in any outpatient setting.

Computed tomography (CT)

The computed tomography (CT) scan is an x-ray test that produces detailed cross-sectional images of your body. Instead of taking one picture, like a standard x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body. A CT scan can provide information about the size, shape, and position of a tumor, and can be helpful to see if the cancer has spread to other organs. It can also help find enlarged lymph nodes that might have cancer cells.

A CT scanner has been described as a large donut, with a narrow table in the middle opening. You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken.

Before the test, you may be asked to drink 1 to 2 pints of a liquid called oralcontrast. This helps outline the intestine so that certain areas are not mistaken for tumors. You may also receive an IV line through which a different kind of contrast dye (IV contrast) is injected. This helps better outline structures such as blood vessels in your body.

The injection can cause some flushing (redness and warm feeling). A few people are allergic to the dye and get hives, or rarely, have more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays.

CT-guided needle biopsy: CT scans can also be used to guide a biopsy needle precisely into a suspected tumor. For this procedure, the patient remains on the CT scanning table, while a doctor moves a biopsy needle through the skin and toward the tumor. CT scans are repeated until the needle is within the mass. A fine-needle biopsy sample or a core needle biopsy sample is removed and looked at under a microscope. This is not used to biopsy vaginal tumors, but it may be used to biopsy possible metastases.

Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) scans use radio waves and strong magnets instead of x-rays to make images of the body. The energy from the radio waves is absorbed by the body and then released in a specific pattern formed by the type of tissue and by certain diseases. A computer translates the pattern into a detailed image of parts of the body. Like a CT scanner, this produce cross-sectional slices of the body. An MRI can also produce slices that are parallel with the length of your body. As with a CT scan, a contrast material might be used, but it is not needed as often.

MRI scans are more uncomfortable than CT scans. They take longer – often up to an hour. You have to be placed inside tube-like equipment. This is confining and can upset people with claustrophobia (a fear of close spaces). If you have trouble with close spaces, let your doctor know before the MRI scan. Sometimes medicine can be given just before the scan to reduce anxiety. Another option is to use a special “open” MRI machine that is less confining and more comfortable for such people, the drawback being that the images from these machines are not as good. The machine also makes a buzzing or clanging noise that some people find disturbing. Some places will provide headphones with music to block this noise.

MRI images are particularly useful in examining pelvic tumors. They may show enlarged lymph nodes in the groin. They are also helpful in finding cancer that has spread to the brain or spinal cord. This rarely occurs in vaginal cancer.

Positron emission tomography

Positron emission tomography (PET) uses glucose (a form of sugar) that contains a low-level radioactive atom. Because cancer cells use glucose at a higher rate than normal cells, they absorb more of the radioactive sugar. The areas of radioactivity are detected with this test.

You will be injected with the special glucose, and then about an hour later you will be moved onto a table in the PET scanner. You lie on the table for about 30 minutes while a special camera creates a picture of areas of radioactivity in the body. The picture is not finely detailed like a CT or MRI scan, but it provides helpful information about your body.

This test can be helpful for spotting collections of cancer cells, and seeing if the cancer has spread to lymph nodes. PET scans are also useful when your doctor thinks the cancer has spread, but doesn’t know where (although they aren’t useful for finding cancer spread in the brain). PET scans can be used instead of several different x-rays because they scan your whole body. Often, a machine that combines a PET scanner and a CT scanner (called a PET/CT) is used, which gives more information about areas of cancer and cancer spread.

PET scans are not often used in patients with early vaginal cancer, but they may be helpful in finding areas of cancer spread.

Endoscopic tests

These tests are not used often to evaluate women with vaginal cancer.

Proctosigmoidoscopy

Proctosigmoidoscopy is a procedure that looks at the rectum and part of the colon. It’s done to check for spread of vaginal cancer to the rectum or colon. In this procedure a slender, flexible, hollow, lighted tube is placed into the rectum. Any areas that look suspicious will be biopsied. This test may be somewhat uncomfortable, but it should not be painful. Proctosigmoidoscopy may be recommended for patients whose vaginal cancers are large and/or located in the part of the vagina next to the rectum and colon.

Cystoscopy

Cystoscopy is a procedure that looks at the inside of the bladder. It’s done to check for spread of vaginal cancer to the bladder. This procedure can be done in the doctor’s office or clinic. You may be given an intravenous drug to make you drowsy. A thin tube with a lens and light is inserted into the bladder through the urethra. If suspicious areas or growths are seen, a biopsy will be done. Cystoscopy may be recommended if a vaginal cancer is large and/or located in the front wall of the vagina, near the bladder.